Trauma Practice Questions

Q: Which of the following statements about Keinböck's osteonecrosis is FALSE?

Pain is more on wrist flexion than wrist extension.. **Explanation:** **Kienböck’s disease** is the avascular necrosis (AVN) or osteochondritis of the **lunate bone**. Understanding the anatomy and biomechanics of the carpus is key to identifying the clinical features. **Why Option B is the FALSE statement:** In Kienböck’s disease, **pain is typically more severe during wrist extension** rather than flexion. This is because, during extension, the lunate is compressed between the distal radius and the capitate. This increased axial loading on the necrotic, structurally weakened lunate exacerbates the pain. **Analysis of other options:** * **Option A:** The lunate is located centrally in the proximal carpal row, directly proximal to the **base of the 3rd metacarpal** (via the capitate). Therefore, localized tenderness is most prominent at this anatomical landmark. * **Option C:** It is indeed classified as **osteochondritis** (idiopathic AVN) of the lunate, similar to Perthes' disease in the hip. * **Option D:** The condition typically affects young adults, most commonly in the **20–40 year** age range, often involving the dominant hand of manual laborers. **High-Yield Clinical Pearls for NEET-PG:** * **Etiology:** Strongly associated with **Ulnar Negative Variance** (the ulna is shorter than the radius), which leads to increased force transmission through the lunate. * **Radiology:** The **Stahl Classification** or **Lichtman Classification** is used for staging. Early stages may show normal X-rays (MRI is the investigation of choice), while late stages show sclerosis, collapse, and carpal instability. * **Treatment:** Depends on the stage; options include radial shortening osteotomy (to correct ulnar negative variance) or proximal row carpectomy in advanced cases.

Q: Hotchkiss terrible triad does not include which of the following injuries?

Olecranon fracture. The **Terrible Triad of the Elbow**, first described by Hotchkiss, refers to a specific injury pattern characterized by severe elbow instability. It is termed "terrible" because it historically carried a poor prognosis with high rates of chronic instability and arthrosis. ### **Explanation of the Correct Answer** **C. Olecranon fracture:** This is the correct answer because it is **not** part of the classic triad. While olecranon fractures can occur alongside elbow trauma, they are typically associated with "Monteggia fracture-dislocations" or "Trans-olecranon fracture-dislocations," which have different injury mechanisms and management protocols than the Hotchkiss triad. ### **Analysis of Incorrect Options** The Hotchkiss Terrible Triad consists of the following three components: * **B. Posterior elbow dislocation/subluxation:** Usually results from a fall on an outstretched hand (FOOSH) with the elbow in semi-flexion, leading to a posterolateral rotatory instability pattern. * **A. Radial head fracture:** The radial head acts as the primary secondary stabilizer against valgus stress; its fracture compromises lateral stability. * **D. Fracture of the coronoid process:** The coronoid process is the "key" anterior stabilizer. Even a small (Regan-Morrey Type I) fracture significantly increases the risk of recurrent posterior dislocation. ### **High-Yield Clinical Pearls for NEET-PG** * **Mechanism:** Valgus stress + Axial loading + Supination (Posterolateral Rotatory Instability). * **Primary Goal of Surgery:** To restore enough stability to allow for **early range of motion** to prevent elbow stiffness (the most common complication). * **Classification:** Coronoid fractures are classified by **Regan-Morrey**, while radial head fractures use the **Mason Classification**. * **Management Priority:** 1. Fix/Replace Radial Head → 2. Repair Coronoid/Anterior Capsule → 3. Repair Lateral Collateral Ligament (LCL).

Q: What is the management of hemarthrosis?

All of the above. **Explanation:** Hemarthrosis refers to bleeding into a joint cavity, most commonly occurring in the knee following trauma (e.g., ACL tear or patellar dislocation) or in patients with bleeding disorders like Hemophilia. The management strategy focuses on pain relief, pressure to control bleeding, and joint stabilization. **Why "All of the above" is correct:** The standard management of acute traumatic hemarthrosis follows a multimodal approach: 1. **Needle Aspiration (Arthrocentesis):** This is both diagnostic and therapeutic. Removing the blood under aseptic conditions provides immediate relief from intense pain caused by joint capsule distension and prevents the proteolytic enzymes in the blood from damaging the articular cartilage. 2. **Compression Bandage (Robert-Jones Bandage):** Applying a firm compression bandage helps limit further intra-articular bleeding and reduces inflammatory edema. 3. **Plaster of Paris (POP) Cast/Slab:** Immobilization is crucial to provide rest to the injured structures, prevent re-bleeding from movement, and alleviate muscle spasms. **Clinical Pearls for NEET-PG:** * **Rapid vs. Slow Swelling:** Swelling appearing within **0-2 hours** post-injury suggests **hemarthrosis** (vascular injury). Swelling appearing after **6-12 hours** suggests **traumatic effusion** (synovial fluid). * **Fat Globules:** If aspirated blood contains fat globules (lipohemarthrosis), it is pathognomonic for an **intra-articular fracture** (e.g., Tibial plateau fracture). * **Most Common Cause:** The most common cause of traumatic hemarthrosis in a stable joint is an **ACL tear**. * **Golden Rule:** Always rule out a fracture via X-ray before performing aspiration or applying a tight cast.

Q: Which nerve is commonly involved in a fracture of the distal shaft of the humerus?

Radial nerve. **Explanation:** The correct answer is **Radial nerve**. This is a classic high-yield anatomical relationship frequently tested in NEET-PG. **1. Why the Radial Nerve is Correct:** The radial nerve travels in the **spiral groove** (radial groove) located on the posterior aspect of the humerus. As it descends, it pierces the lateral intermuscular septum to enter the anterior compartment in the distal third of the arm. In fractures of the **distal third of the humeral shaft** (specifically **Holstein-Lewis fractures**), the nerve is prone to entrapment or laceration because it is relatively fixed against the bone at this site. **2. Why the Other Options are Incorrect:** * **Median Nerve:** This nerve travels medially and is more commonly injured in **supracondylar fractures** of the humerus (extension type), rather than shaft fractures. * **Ulnar Nerve:** The ulnar nerve is most vulnerable at the **medial epicondyle** (cubital tunnel). It is rarely involved in shaft fractures unless there is significant medial displacement. * **Circumflex Brachial (Axillary) Nerve:** This nerve winds around the **surgical neck** of the humerus. It is the most common nerve injured in proximal humerus fractures or anterior shoulder dislocations. **3. Clinical Pearls for NEET-PG:** * **Holstein-Lewis Fracture:** A spiral fracture of the distal 1/3rd of the humerus associated with radial nerve palsy. * **Clinical Sign:** Radial nerve injury leads to **Wrist Drop** (loss of wrist and finger extensors) and sensory loss over the first dorsal web space. * **Management:** Most radial nerve palsies in closed humeral fractures are **neuropraxias** and recover spontaneously (85-90% recovery rate). Immediate exploration is only indicated in open fractures or if the palsy develops *after* manipulation.

Q: What is considered the golden hour for a femur fracture?

1 hour after injury. **Explanation:** The concept of the **"Golden Hour"** in trauma refers to the critical period immediately following a traumatic injury, such as a femur fracture, during which prompt medical intervention and stabilization significantly increase the chances of survival and reduce long-term morbidity. **1. Why Option A is Correct:** The "Golden Hour" begins at the **moment of injury**. In high-energy trauma like a femur fracture, the patient is at high risk for life-threatening complications, including **hypovolemic shock** (due to significant internal blood loss, often 1–1.5 liters) and **fat embolism syndrome**. Immediate resuscitation, immobilization (using a Thomas splint), and stabilization within this first hour are vital to prevent the "lethal triad" of acidosis, coagulopathy, and hypothermia. **2. Why the Other Options are Incorrect:** * **Option B:** This is logically impossible as medical intervention cannot occur before the injury happens. * **Option C:** Waiting until the patient reaches the hospital ignores the "Platinum Ten Minutes" of pre-hospital care. If transport is delayed, the golden hour may be exhausted before arrival. * **Option D:** This refers to the post-operative recovery phase, which is important for rehabilitation but does not define the emergency stabilization window. **High-Yield Clinical Pearls for NEET-PG:** * **Blood Loss:** A closed femoral shaft fracture can lead to **1000–1500 ml** of internal hemorrhage. * **Splintage:** The **Thomas Splint** is the gold standard for emergency immobilization to prevent further soft tissue damage and reduce fat embolism risk. * **Fat Embolism Syndrome (FES):** Classically presents with the triad of dyspnea, confusion, and petechial rashes (usually 24–72 hours post-injury). * **Management:** Early Total Care (ETC) vs. Damage Control Orthopaedics (DCO) depends on the patient's hemodynamic stability.

Q: Which tendon is affected in lateral epicondylitis?

Extensor Carpi Radialis Brevis. **Explanation:** **Lateral Epicondylitis**, commonly known as **Tennis Elbow**, is a clinical condition characterized by pain and tenderness over the lateral epicondyle of the humerus. It is caused by repetitive microtrauma and overuse, leading to angiofibroblastic hyperplasia (degenerative changes) rather than true inflammation. 1. **Why Option A is Correct:** The **Extensor Carpi Radialis Brevis (ECRB)** is the most commonly involved tendon. It originates from the lateral epicondyle. Because of its anatomical position, the underside of the ECRB tendon rubs against the lateral capitellum during elbow extension and forearm pronation, making it highly susceptible to wear, tear, and microscopic failure. 2. **Why Other Options are Incorrect:** * **Extensor Carpi Radialis Longus (ECRL):** While it originates near the lateral epicondyle (supracondylar ridge), it is rarely the primary site of pathology in tennis elbow. * **Flexor Pollicis Longus:** This is a deep muscle of the anterior (flexor) compartment of the forearm. It is unrelated to lateral epicondylar pathology. * **Supinator:** Although the supinator lies deep in the lateral elbow, it is not the primary tendon involved. However, the **posterior interosseous nerve** passes through the supinator (Arcade of Frohse), which is a differential diagnosis for lateral elbow pain (Radial Tunnel Syndrome). **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Test:** **Cozen’s Test** (pain on resisted wrist extension with elbow extended) and **Mill’s Test** (pain on passive wrist flexion with elbow extended). * **Medial Epicondylitis (Golfer’s Elbow):** Involves the common flexor origin, most commonly the **Pronator Teres** and **Flexor Carpi Radialis (FCR)**. * **Treatment:** Primarily conservative (NSAIDs, eccentric exercises, bracing). Surgery (Nirschl debrisment) is reserved for refractory cases.

Question 1

What is the treatment of choice in pathological fractures?

Accepted Answer

Internal fixation

Answer

Plaster of Paris casts

Answer

Skin traction

Answer

External skeletal fixation

Question 2

Which of the following statements about Keinböck's osteonecrosis is FALSE?

Accepted Answer

Pain is more on wrist flexion than wrist extension.

Answer

Tenderness over the base of the 3rd metacarpal is present.

Answer

It is osteochondritis of the lunate.

Answer

The common age group is 20-40 years.

Question 3

In a Guardsman fracture, what type of fractures are present?

Accepted Answer

Direct fracture of the symphysis with an indirect fracture of the bilateral subcondyle.

Answer

Indirect fracture of the symphysis with a direct fracture of the bilateral subcondyle.

Answer

Direct fracture at both the symphysis and the bilateral subcondyle.

Answer

Any of the above combinations.

Question 4

Hotchkiss terrible triad does not include which of the following injuries?

Accepted Answer

Olecranon fracture

Answer

Head of radius fracture

Answer

Posterior elbow subluxation

Answer

Fracture of coronoid process

Question 5

What is the management of hemarthrosis?

Accepted Answer

All of the above

Answer

Compression bandage

Answer

Needle aspiration

Answer

Plaster of Paris cast

Question 6

Which nerve is commonly involved in a fracture of the distal shaft of the humerus?

Accepted Answer

Radial nerve

Answer

Median nerve

Answer

Ulnar nerve

Answer

Circumflex brachial nerve

Question 7

What is the most important cause of nonunion of a humeral shaft fracture?

Accepted Answer

Distraction at fracture site

Answer

Comminuted fracture

Answer

Compound (Open) fracture

Answer

Overriding of fracture ends

Question 8

What is considered the golden hour for a femur fracture?

Accepted Answer

1 hour after injury

Answer

1 hour prior to injury

Answer

1 hour after reaching the hospital

Answer

1 hour after surgical procedure

Question 9

All of the following areas are commonly involved sites in pelvic fracture except?

Accepted Answer

Ischial tuberosities

Answer

Pubic rami

Answer

Alae of ilium

Answer

Acetabulum

Question 10

Which tendon is affected in lateral epicondylitis?

Accepted Answer

Extensor Carpi Radialis Brevis

Answer

Extensor Carpi Radialis Longus

Answer

Flexor Pollicis Longus

Answer

Supinator

Trauma — MCQs

Trauma — MCQs

On this page

Practice by Chapter

Want unlimited practice?